Facilitators and barriers for high-reliability training in medical centers
Bibliographic record
Abstract
Objective: The study aims to determine the facilitators and barriers to conducting large-scale CRM-based training in a national health care system (VHA). While there are some studies on this topic, none review training in a federal system or provide data on changes within the system.Methods: Design: Focus Groups collecting qualitative data. Review Methods: We held focus-groups for Clinical Team Training (CTT) facility Points of Contact (POC) and CTT Master Trainers. Responses were collected live and presented to all participants in each focus group session to ensure participant comfort and accuracy. All subgroup leaders agreed on iteratively and qualitatively reviewing participant responses from the four open-ended and three poll questions. Each subgroup leader was assigned a question to conduct a preliminary review of participant responses. After the initial review, a second leader also reviewed the participant responses. Over multiple iterations, themes emerged and were formalized by the team.Results: The focus groups revealed that Leadership engagement in cultural change is imperative. The focus groups also identified that language and examples used in the curriculum may have inadvertently marginalized individuals by making some non-clinical team members feel excluded as part of the team. Our results support the need for highly visible leadership engagement, adequate time to undertake and complete projects, and overcoming skepticism. See table 1 for themes from each question.Conclusions: Qualitative analysis revealed that Leadership engagement in cultural change is imperative. Focus groups identified that specific language and examples used in the curriculum may have inadvertently marginalized individuals who do not have clinical backgrounds. In addition, some participants felt that the use of the term “Projects” created a negative connotation for the required quality improvement project on each unit and instead preferred the terms “micro-project,” “safety strategy,” or “quick wins.”Implemented changes: The program’s name has been rebranded to NCPS Team Training, taking the word clinical out to be more inclusive of all team members who engage in the care of a patient in the clinical setting. A complimentary video series was developed for facility Master Trainers to use as a supplement to their teaching or exclusively as the teaching tool as they facilitate the tabletop simulation exercises. Another change is that the Unit Based Safety Project has been renamed as Unit Based Safety Initiative (UBSI) to remove the stigma of a “project.”
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".